This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Polycystic Ovary Syndrome (PCOS), the most common endocrine condition in women of childbearing age, is characterized by hyperandrogen states, menstrual irregularities, glucose dysregulation, and abnormal adipose deposition. This condition, affecting 5-10% of adult women, often presents with oligomenorrhea or amenorrhea, infertility, hirsutism, acne, and/or obesity. Women with PCOS have up to a 2-4 fold increase in the prevalence of metabolic syndrome, and thus increased risk of cardiovascular disease and type 2 diabetes compared with controls. Standard medical therapy includes agents which lower systemic androgen levels, namely, oral contraceptive and metformin. Physical activity has been shown to reduce risk profile in patients with metabolic syndrome. Examination of adipokines, hormones and protein signals released from adipose tissue has occurred in these women, but these studies are limited in that they have been cross-sectional in design. The goal of this project is to evaluate the effect of adipose tissue biomarkers and anthropometric measures of adding physical activity to the standard of care antiandrogen, metformin. Longitudinal changes in adipokines, steroid hormones, and metabolic risk profiles will be examined in patients with PCOS randomized to a 3 month metformin treatment plus exercise training program or a metformin treatment without exercise training.